Eastern Diet - A Healthful Dietary Pattern from Eastern China: Its Characteristics and Relation to Adiposity, Cardiometabolic Diseases, Mortality and Gut Microbiota

AimThe dietary pattern in the downstream Yangtze River region of Eastern China has garnered widespread attention for its potential health benefits but lacks empirical evidence. This study aimed to identify and characterize this dietary pattern, develop a dietary pattern index, and evaluate its associations with adiposity, cardiometabolic diseases (CMDs), mortality, and gut microbiota. MethodsThis study used data from 8665 participants aged 18-80 years in the WELL-China cohort (2016-2019, Hangzhou, Eastern China) as the discovery cohort. K-means clustering identified an "Eastern Diet" (EastDiet) pattern and an adherence index based on the 12 food groups and flavor preferences were developed. Adiposity was measured using dual-energy X-ray absorptiometry. Incident CMDs and mortality were tracked through June 2024. Validation involved two external cohorts. ResultsThe EastDiet pattern was identified characterizing by high plant-based and aquatic food consumption, low refined grains and red meat intake, and a high preference for light-flavored. EastDiet index was favorably associated with lower adiposity. Comparing the highest to the lowest adherence tertiles, hazard ratios (HRs) for CMDs, type 2 diabetes, and cardiovascular diseases were 0.75 (95% CI: 0.62-0.90), 0.76 (0.60-0.96), and 0.71 (0.53-0.94), respectively. All-cause mortality was similarly reduced. Gut microbiota profiles associated with higher EastDiet adherence were linked to improved adiposity and reduced CMDs risk. Validation cohorts replicated these findings. ConclusionThis study identified and characterized the EastDiet pattern from Eastern China and determined its health benefits. Our findings highlighted the potential of the EastDiet as a healthful dietary pattern for Chinese population.